# Effect of support for low-income mothers of preterm infants on parental caregiving in the NICU

> **NIH NIH R01** · UNIV OF MASSACHUSETTS MED SCH WORCESTER · 2024 · $679,106

## Abstract

PROJECT SUMMARY / ABSTRACT
Preterm birth is the leading cause of childhood mortality and developmental disabilities and costs $26 billion
annually. A critical modifier of preterm infant health and development is maternal presence during the birth
hospitalization, which facilitates breast milk provision, participation in skin-to-skin care and allows mothers to
benefit from training in post-discharge infant care practices. However, these benefits can only be realized if
mothers are able to visit their hospitalized preterm infants for several hours per day, actively engage in
caregiving and receive training from staff during the many weeks of a typical preterm birth hospitalization.
Regularly visiting a neonatal intensive care unit (NICU) requires mothers to shoulder significant costs, including
parking, childcare for other children, transportation, and accommodations, in addition to forgoing income.
Moreover, new evidence suggests that the psychological burden of financial strain may worsen mental health
outcomes (including stress and depression) and impede cognitive functions such as attention, memory, and
inhibitory control, which may further impede low-income mothers’ participation in NICU caregiving. Building on
a feasibility trial conducted by our team, we propose to conduct a 1:1 randomized control trial to rigorously test
the impact of financial transfers versus standard of care (control) among 420 low-income mothers with infants
25-33 weeks’ gestation in 3 level 3 NICUs (1 urban, 1 urban/suburban and 1 suburban/rural). Mothers in the
intervention arm will receive a transfer of $160 per hospital week with a one-time “label” or scripted message
that explains that the transfer is intended for them to visit and care for their hospitalized infant. Our primary
hypothesis is that financial transfers can enable economically disadvantaged families to visit the NICU, reduce
the negative psychological impacts of financial distress, increase maternal caregiving behaviors associated
with positive preterm infant health and development and potentially reduce health systems costs. In Aim 1, we
will examine the impact of financial transfers on primary NICU caregiving behaviors --breastmilk provision and
skin-to-skin care-- and secondary 1-2 month post-discharge caregiving behaviors-- safe sleep practices. In Aim
2, we will consider mechanisms of action, including mediators (NICU visitation, mental health, and cognitive
function) of the relationship between financial transfers and caregiving behaviors of interest. We will also
qualitatively explore maternal perspectives of financial transfers, mediators of its impact, and other barriers and
facilitators to maternal caregiving. In Aim 3, we will conduct exploratory analysis of cost drivers (length of stay,
30-day readmission and ED use). This simple and scalable intervention has tremendous potential to improve
equity in health care access by enabling key populations to utilize existing clinical supports durin...

## Key facts

- **NIH application ID:** 10894017
- **Project number:** 5R01HD109293-03
- **Recipient organization:** UNIV OF MASSACHUSETTS MED SCH WORCESTER
- **Principal Investigator:** Margaret McConnell
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $679,106
- **Award type:** 5
- **Project period:** 2022-09-01 → 2027-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10894017

## Citation

> US National Institutes of Health, RePORTER application 10894017, Effect of support for low-income mothers of preterm infants on parental caregiving in the NICU (5R01HD109293-03). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10894017. Licensed CC0.

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